Tethered cord syndrome doesn’t only affect childhood. In adults it can present with neuropathic low-back pain, gait changes, urinary symptoms, or subtle sensory issues that go unnoticed. This guide covers the common warning signs, the tests that truly help, and when to refer to a specialized center. It includes treatment options, realistic recovery timelines, and a checklist to prepare for the consultation.
What is tethered cord in adults?
Tethered cord occurs when the spinal cord is “anchored” by abnormal tissue or adhesions that limit its mobility. Over time, chronic stretch can cause pain, sensory changes, or weakness. In adults it may be secondary to mild spinal dysraphism, scarring, trauma, or prior surgery. Symptom variability often leads to confusion with other causes of low-back pain or radiculopathy.
9 warning signs to pay attention to
1) Low-back pain with atypical radiation
Burning or electric-shock–like pain radiating to the buttocks, groin, or the back of the legs. It can worsen with sustained postures or maneuvers that “tension” the spine.
2) Gait changes or frequent tripping
A feeling that a leg “gives way,” shorter steps, or instability on uneven ground.
3) Urinary or bowel changes
Urgency, leakage, or a sense of incomplete emptying. Some cases develop persistent constipation or changes in anal control.
4) Tingling, numbness, or sensory loss
Dysesthesias in the legs or perineum that don’t fit a single “classic” dermatome.
5) Weakness or unusual fatigue on stairs
Especially if progressive and not relieved by rest.
6) Pain that varies with posture
Partial relief in flexion (sitting) and worsening with sustained extension.
7) History of lumbar surgery or trauma
Scarring or certain procedures can promote dural adhesions.
8) Congenital lumbosacral skin stigmata
Midline hair patches, dimples, or marks may suggest occult dysraphism.
9) Pregnancy or sports that “unmask” prior symptoms
Higher demand or biomechanical changes can reveal symptoms in people with limited reserve.
How the diagnosis is confirmed
History and neurological examination
Assess strength, reflexes, and sensation (including perineal area when appropriate) and gait. Document the impact on daily life and the time course.
Magnetic resonance imaging (MRI)
The key test. Look for a low-lying conus, evidence of traction, CSF changes, and adhesions. In complex cases, some centers consider prone MRI or dynamic studies to show subtle CSF-flow obstruction.
Urodynamics and complementary tests
If urinary symptoms are present, urodynamic studies help objectify dysfunction. Laboratory tests and neurophysiology can support the differential diagnosis.
Differential diagnosis
- Radiculopathies due to herniation or spinal canal stenosis.
- Adhesive arachnoiditis or postsurgical epidural fibrosis.
- Syringomyelia and other intramedullary cavities.
- Non-neurogenic pelvic floor disorders.
Treatment options
Conservative approach
For mild or stable symptoms: pain education, physiotherapy focused on motor control and activity tolerance, sleep measures and stress management, and individualized pharmacologic treatment for neuropathic pain. The goal is to improve function and quality of life.
When to consider surgery
With meaningful functional impact, neurological progression, refractory pain, or documented urologic dysfunction, surgical release (“untethering”) may be considered. The aim is to reduce traction, stabilize or improve symptoms, and prevent further decline. Not all cases are candidates: indication depends on correlating symptoms and imaging in an experienced unit.
Benefits versus risks and adverse effects
Expected benefits: reduction of neuropathic pain, improved gait and sensation, and— in selected profiles—better urinary function. Outcomes depend on etiology, symptom duration, and the presence of syringomyelia or other associated conditions.
Risks/limitations: infection, CSF leak, rare neurological worsening, recurrent adhesions, and need for re-operation. Align expectations: often the goal is to halt progression and achieve realistic functional gains.
Practical referral criteria
- Moderate/high clinical suspicion with compatible or equivocal MRI.
- New or progressive neurological deficits.
- Documented urinary dysfunction (especially new or worsening).
- Disabling neuropathic pain despite well-executed conservative care.
Realistic recovery timelines
After surgery, hospital stay is usually brief. Functional recovery advances over weeks and continues for several months. Targeted physiotherapy, pain control, and urologic follow-up when needed are key. With conservative care, improvement is gradual; sustained habits (adapted physical activity and sleep) make the difference.
When to go to the emergency department
- Sudden loss of strength or sensation in the legs.
- New-onset incontinence or acute urinary retention.
- High fever with severe vertebral pain.
- Day-to-day rapid worsening despite analgesia.
Myths vs realities
“MRI always gives the definitive answer.” Not in every case; clinical judgment and, at times, additional studies are decisive.
“Surgery cures it forever.” Surgery can improve and stabilize, but recurrences and individual variability exist.
“If it hurts, total rest.” Prolonged rest worsens the condition; graded activity is preferable.
Frequently asked questions
Can tethered cord first appear in adulthood?
Yes. It is sometimes diagnosed late or becomes symptomatic due to biomechanical changes, prior surgeries, or physical demand.
Does MRI always detect the problem?
It’s the key test, but some cases require specific protocols or additional studies to confirm.
When is surgery necessary?
When there is neurological deterioration, refractory pain, or urinary involvement, and the clinical–imaging correlation supports it.
Is improvement immediate?
Most often improvement is gradual over weeks to months; the goal may be both to improve and to stop progression.
What if I’m not a surgical candidate?
A multimodal plan is prioritized: adapted exercise, neuropathic pain management, sleep, and pain education.
Important
This content is educational and does not replace medical evaluation. If you have red-flag signs or diagnostic doubts, seek professional care.
References
Dr. Gilete’s site – Specialty: Tethered cord syndrome: https://drgilete.com/es/servicios/evaluacion-del-sindrome-de-medula-anclada/
NORD – Tethered Cord Syndrome: https://rarediseases.org/es/rare-diseases/tethered-cord-syndrome/ Rare Diseases
Stanford Children’s – Tethered Cord (general symptom reference): https://www.stanfordchildrens.org/es/services/tethered-cord-syndrome.html Stanford Children’s Health
Drugs.com (ES) – Tethered cord syndrome: https://www.drugs.com/cg_esp/s%C3%ADndrome-de-la-m%C3%A9dula-anclada.html Drugs.com
Wikipedia (EN) – Tethered cord syndrome (adult symptoms; use with caution): https://en.wikipedia.org/wiki/Tethered_cord_syndrome
Christopher & Dana Reeve Foundation – Syringomyelia and tethered cord: https://www.christopherreeve.org/international/vivir-con-par%C3%A1lisis/salud/causas-de-paralisis/siringomielia-y-medula-espinal-anclada-reeve-foundation/ Christopher & Dana Reeve Foundation
